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CGHS RATES FOR HOSPITALS WILL BE INCREASED SOON

Govt likely to hike CGHS rates in July, cancer & bypass surgery packages among 1,800 up for revision.

Rates for most packages — over 1,800, which cover most major medical procedures like bypass surgery, surgeries for cancer and knee replacement etc — likely to go up by 5-30%. 

SUMI SUKANYA DUTTA    

29 May, 2023 5:09 pm IST

New Delhi: The Union health ministry is in the process of hiking the rates of packages under the Central Government Health Scheme (CGHS), with the new arrangement likely to kick in 1 July, ThePrint has learnt. The hike will benefit hospitals.  

Senior officials in the health ministry told ThePrint that rates for most packages — over 1,800, which cover most major medical procedures like bypass surgery, surgeries for cancer and knee replacement etc — will go up by 5 to 30 per cent. 

“This will be the first time since 2014 when the rates of the procedures under the CGHS will be revised. We are hoping to notify the new rates in June and they will be applicable from 1 July this year,” said a senior official who did not wish to be named.

“The rates for a small number of procedures such as Magnetic Resonance Imaging (MRI), however, will come down marginally as the MRI rates have decreased over the last several years,” the official added. 

CGHS is the nodal healthcare provider that covers nearly 42 lakh beneficiaries across 79 cities, including all current and retired central government employees and their families, according to official data.

For every procedure, a predetermined rate is paid by the government to the hospital, so the latest move, when enforced, will not affect beneficiaries.

As part of the scheme, beneficiaries can avail of out-patient and in-patient services in designated hospitals at rates that are much lower than those paid by other patients.

Nearly 2,100 hospitals, including corporate, medium and small establishments, are empanelled under the scheme.

Dr Alexander Thomas, president of the Delhi-based Association of Healthcare Providers of India (AHPI) — the largest network of private hospitals representing over 500 hospitals in India — told ThePrint that the hospitals are keenly awaiting the new order as the ongoing CGHS rates have made it difficult for hospitals to sustain. 

“I think most package rates need to go up by at least 30-50 per cent,” Thomas told ThePrint.

In April this year, the ministry had revised the CGHS package rates for consultation fees, Intensive Care Unit (ICU) charges and room rent. While the out-patient department (OPD) consultation fee for beneficiaries had gone up to Rs 350 from Rs 150, the consultation fee for in-patient department was raised to Rs 350 from Rs 300. 

Similarly, ICU charges had been raised to Rs 862 plus room rent from Rs 750 plus room rent (fixing the ceiling at Rs 5,400). The hike in room rent saw the rate revised to Rs 1,500 from Rs 1,000 for general wards, Rs 3,000 from Rs 2,000 for semi-private wards, and Rs 4,500 from Rs 3,000 for private wards. 

The referral process under CGHS had also been simplified. Earlier, a CGHS beneficiary had to visit the CGHS Wellness Centre in person and take referral for a hospital. But now, they can request a referral through a video call or by sending someone to the primary care centre on their behalf. 

(Edited by Anumeha Saxena)